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Practice Variations Among Pediatricians and Family Physicians in the Management of Otitis Media

Practice Variations Among Pediatricians and Family Physicians in the Management of Otitis Media Abstract Objectives: To determine theoretical practice patterns and Medicaid practices in the management of persistent and recurrent otitis media by family physicians and pediatricians in Colorado. Methods: Members of the Colorado chapters of the American Academy of Pediatrics and the Colorado Academy of Family Medicine were surveyed with the use of two hypothetical case management scenarios for which they were asked to indicate which International Classification of Diseases, Ninth Revision, Medicaid codes they would use. Physicians were presented with two case scenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to choose from a variety of management options, including observation, antibiotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery. Results: Family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavulanate potassium, cefaclor, or cefixime) to treat persistent middle ear effusions twice as often as pediatricians would have (P<.002). At the 6-week visit, 50 family physicians (43%) would administer an oral decongestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P<.001). Family physicians would refer patients for ventilating tube surgery three times more often than pediatricians at the 9-week visits (P<.001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Respondents reported a wide variety of International Classification of Diseases, Ninth Revision, coding, often coding persistent effusions as acute otitis or as unspecified otitis media. Conclusions: The findings of this survey document the wide variation in practice patterns for treating children with persistent otitis media and children with recurrent otitis media in Colorado.(Arch Pediatr Adolesc Med. 1995;149:839-844) References 1. Howie VM, Schwartz RH. Acute otitis media: one year in general pediatric practice . AJDC . 1983;137:155-158. 2. Schappert SM. Office Visits for Otitis Media: United States, 1975-1990 . In: Advance Data from Vital and Health Statistics, Centers for Disease Control . Atlanta, Ga: National Center for Health Statistics; 1992:214. 3. Mandel EM, Bluestone CD, Paradise JL, et al. Efficacy of myringotomy with and without tympanostomy tube insertion in the treatment of chronic otitis media with effusion in infants and children: results for the first year of a randomized clinical trial . In: Lim DJ, ed. Recent Advances in Otitis Media With Effusion . Philadelphia, Pa: BC Decker Inc; 1984:308-312. 4. Berman S. Otitis media with effusion: its relationship to language development, intellectual functioning and academic performance . Adv Behav Pediatr . 1981;2:129. 5. Teele DW, Klein JO, Chase C, Menyuk P, Rosner BA, Greater Boston Otitis Media Study Group. Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years . J Infect Dis . 1990;160:83-94.Crossref 6. Nuss R, Berman S. Medical management of persistent middle ear effusion . Am J Asthma Allergy Pediatr . 1990;4:17-22. 7. Stool SE, Berg AO, Berman S, et al. Otitis media with effusion in young children . In: Clinical Practice Guidelines in Young Children . Rockville, Md: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; July 1994. Clinical Practice Guideline 12. AHCPR Publication 94-0622. 8. Green SM, Rothrock SG. Single-dose intramuscular ceftriaxone for acute otitis media in children . Pediatrics . 1993;91:23. 9. Rosenfield RM, Post JC. Meta-analysis of antibiotics for the treatment of otitis media with effusion . Otolaryngol Head Neck Surg . 1992;106:378-386. 10. Berman S, Roark R, Luckey D. Theoretical cost effectiveness of management options of children with persisting middle ear effusions . Pediatrics . 1994;93:353-363. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Practice Variations Among Pediatricians and Family Physicians in the Management of Otitis Media

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170210013002
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To determine theoretical practice patterns and Medicaid practices in the management of persistent and recurrent otitis media by family physicians and pediatricians in Colorado. Methods: Members of the Colorado chapters of the American Academy of Pediatrics and the Colorado Academy of Family Medicine were surveyed with the use of two hypothetical case management scenarios for which they were asked to indicate which International Classification of Diseases, Ninth Revision, Medicaid codes they would use. Physicians were presented with two case scenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to choose from a variety of management options, including observation, antibiotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery. Results: Family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavulanate potassium, cefaclor, or cefixime) to treat persistent middle ear effusions twice as often as pediatricians would have (P<.002). At the 6-week visit, 50 family physicians (43%) would administer an oral decongestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P<.001). Family physicians would refer patients for ventilating tube surgery three times more often than pediatricians at the 9-week visits (P<.001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Respondents reported a wide variety of International Classification of Diseases, Ninth Revision, coding, often coding persistent effusions as acute otitis or as unspecified otitis media. Conclusions: The findings of this survey document the wide variation in practice patterns for treating children with persistent otitis media and children with recurrent otitis media in Colorado.(Arch Pediatr Adolesc Med. 1995;149:839-844) References 1. Howie VM, Schwartz RH. Acute otitis media: one year in general pediatric practice . AJDC . 1983;137:155-158. 2. Schappert SM. Office Visits for Otitis Media: United States, 1975-1990 . In: Advance Data from Vital and Health Statistics, Centers for Disease Control . Atlanta, Ga: National Center for Health Statistics; 1992:214. 3. Mandel EM, Bluestone CD, Paradise JL, et al. Efficacy of myringotomy with and without tympanostomy tube insertion in the treatment of chronic otitis media with effusion in infants and children: results for the first year of a randomized clinical trial . In: Lim DJ, ed. Recent Advances in Otitis Media With Effusion . Philadelphia, Pa: BC Decker Inc; 1984:308-312. 4. Berman S. Otitis media with effusion: its relationship to language development, intellectual functioning and academic performance . Adv Behav Pediatr . 1981;2:129. 5. Teele DW, Klein JO, Chase C, Menyuk P, Rosner BA, Greater Boston Otitis Media Study Group. Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years . J Infect Dis . 1990;160:83-94.Crossref 6. Nuss R, Berman S. Medical management of persistent middle ear effusion . Am J Asthma Allergy Pediatr . 1990;4:17-22. 7. Stool SE, Berg AO, Berman S, et al. Otitis media with effusion in young children . In: Clinical Practice Guidelines in Young Children . Rockville, Md: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; July 1994. Clinical Practice Guideline 12. AHCPR Publication 94-0622. 8. Green SM, Rothrock SG. Single-dose intramuscular ceftriaxone for acute otitis media in children . Pediatrics . 1993;91:23. 9. Rosenfield RM, Post JC. Meta-analysis of antibiotics for the treatment of otitis media with effusion . Otolaryngol Head Neck Surg . 1992;106:378-386. 10. Berman S, Roark R, Luckey D. Theoretical cost effectiveness of management options of children with persisting middle ear effusions . Pediatrics . 1994;93:353-363.

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Aug 1, 1995

References